Thursday, September 13, 2018

House Speech about LCD Clarification Act (September 12, 2018)

Mr. Speaker, today I rise in support of
HR 3635, the local coverage
determination clarification Act.

I
introduced this legislation along with
Congressman [Kind] which will help ensure
the Medicare coverage decisions are made
by qualified health experts through a
transparent process that is based on
sound medical evidence.

Medicare
administrative contractors or Macs play
a critical role in ensuring that
Medicare beneficiaries have access to
needed care.

However the less than transparent
process used by Mac's to make coverage
decisions can limit or deny patients
access to necessary care.

Specifically
the science that guides some of these
decisions can be flawed mischaracterized
or misapplied.

The deliberations and
decisions of the Mac's which should be
based on medical science are often
conducted behind closed doors, with
little opportunity for interested
stakeholders to raise issues or offer
alternatives.

These decisions affect
millions of Medicare beneficiaries and
impact crucial access to innovative
technologies and services. The
establishment of a clear process
informed by health experts will make the
local coverage determination or LCD
process, and the decisions developed by
that process, more sound more transparent
and ensure accountability among Mac's.

Specifically HR 3635 would improve
the LCD process by requiring that
carrier advisory committee meetings of
the Mac are open public and on the
record with minutes taken and posted to
the Mac's website for public inspection.

The gravity of limiting or precluding
coverage for both beneficiaries and
practitioners heightens the need for
transparency especially when such
meetings are currently closed off.

Mac's would be required to include at
the outset of the coverage determination
process a description
of the evidence of Max considered when
considering a local coverage
determination - as well as the rationale
it applies on to deny coverage.

Additionally under current rules local
coverage determinations are essentially
unreviewable once they become final.

This
legislation would create a process for
stakeholders to request additional
review of a max local coverage decision
from the Centers for Medicare and
Medicaid Services.

It would also require
the secretaries to submit a report to
Congress regarding the number of
requests filed with fiscal
intermediaries and carriers and the
number of appeals filed with the
Secretary as well as the actions in
response.

Additionally the report would recommend
ways to improve the usefulness and
effective efficiency of the process as
well as the communication from Medicare
beneficiaries and providers.

I'm
pleased that the legislation we have
here today take steps to improve the
process and bring transparency to
protect access for Medicare patients.

We
must continue to work to ensure that
Mac's independently evaluate the
evidence of other max coverage decisions
local coverage determinations should be
thoroughly evaluated by experts in each
local jurisdiction.

Currently loopholes
in the process allow contractors to
adopt another macs coverage determination
without the necessary scientific rigor
and meaningful engagement with
stakeholders that is vital to informing
the most appropriate policy, due to
regional Geographic and population-based
differences.

These carbon copy LCDs may
not reflect the specific geographic
region they are intended to serve local
coverage determinations should be just
that local but simply what works best
for one location dan does not always
work best for another location.

Applying
local coverage determinations across
jurisdictions has the practical effect
of establishing national coverage
policies - without having followed the
more rigorous national coverage
determination process.

As such I look
forward to working with my colleagues on
this issue moving forward.

Medicare
beneficiaries deserve transparency and
accountability for these decisions that
directly impact their access to care.

These reforms are necessary to ensure
that local coverage determinations do
not impede a physician's medical
judgment and deny patients access to
medically necessary care.

By changing the
LCD process Congress can ensure that
medical and scientific evidence is not
used selectively to deny appropriate
coverage to seniors.

I want to thank Mr.
Kyne who joined me in introducing this
legislation, I want to ask my colleagues
for their bipartisan support of this
bill as we work to improve access and
care for every American.

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About Me

Bruce Quinn MD PhD is an expert on health reform, innovation, and Medicare policy. He helps both large and small companies understand and overcome hurdles to commercialization, as well as craft business strategies for a changing environment. CONTACT Dr. Quinn through www.brucequinn.com. BACKGROUND: Dr. Quinn has worked in academic medicine, Accenture business strategies, and for the Medicare program. EDUCATION: Stanford MD/PhD, MIT Postdoc, Kellogg MBA.